25 Jul 10 tips from Georgina Craig

Top tips for transformation making things better for everyone

When GP View asked me to write a blog on how to do transformation, I admit I was a bit apprehensive.

I fear that the termis the latest victim of that fatal NHS infection – ‘jargonitis.’ Like ‘vanguard’, ‘pathfinder’, ‘sustainability’, ‘patient-centred’ and the rest, it is so overused and tainted with political overtones that it invokes an immediate sense of heart sink.

If it is any is any consolation, I spend most of my time, supporting the NHS and its various constituent parts to do things differently, and it makes me feel that way too!

I used to associate transformation with caterpillars becoming butterflies and tear jerking episodes of DIY SOS, but now not so much… That makes me a bit sad because it really is a lovely word.

So let’s forget the “T word” and focus on how wemake things better for everyone, which is what transformation should be about. And by everyone, I mean the people who use NHS services and their families and those who work in GP practices and other parts of the system.

There are lots of fancy theories about managing change. I am not going to quote them (although the evidence is there if you need it). I am a pragmatist. This is what I have found works in primary care. And I recently did some qualitative research with practice managers and practice nurses in the North West. They told me the same things so I hope this resonates.

1. Be a great GP champion. Walk the walk.

GPs are the main drivers for change. They set the tone and create culture through their values, beliefs and actions.A good champion is passionate about making it happen and infects others with their enthusiasm. They make sure people (including patients) have permission to get on with it. When the going gets tough,great GP champions steps up and ‘unblock the drain’ to get things moving again.

2. Talk to affected people. Find out what is really going on.

It is human nature to rush into solutions mode before we really understand the problem.

Before that, we need to get to the bottom of the story and work out what is really going on. It is a bit like taking a comprehensive patient history to support diagnosis.

The only people who cando that are those affected by the change.Usually staff and patients, talking to both is key.

Often this gets swept under the carpet -sometimes because we are afraid to ask; sometimes because we are in a rush to take action.

In fact, it’s the most important part because if you get it wrong, it costs you dearly in the long run. Create a safe space for people to talk. Keep quiet and listen actively. Look at Experience Based Co Design and Appreciative Inquiry for inspiration on how to do it well.

3. Take time out to set a shared ambition with the whole team.

Setting a shared ambition that everyone owns increases the chance of success. Have a simple statement (even better a visual summary) that everyone has a say in creating and which describes what success looks like. Pin it on the wall. It will energise people and provide a reminder of why the team is doing the work. It is also really useful as a way of reminding us how far we have come.

4. Let staff and patients come up with solutions.

The people who imagine the best solutions are the ones closest to the problem. If you have a problem with DNAs (Did Not Attend), ask the receptionists and people who DNA to solve it. It means letting go of power. If it feels uncomfortable, then you are probably on the right track.

5. Have a plan. Review it regularly.

A simple programme plan is important. Have a list of deliverables, a description of each task, a responsible person assigned to each of them and clear deadlines. Use a traffic light system. Turn ambers to reds when you reach each milestone. Have a set review at the same time every week (especially in the early days). Make it a ‘standing meeting’ so you keep it short, sweet and to the point.

6. Make change incrementally and over time.

It is amazing what you achieve when you make small changes over time. Small changes build confidence and positive relationships. They energise and sustain action. Set the expectation that improvement is continuous. We can always be even better. Make today’s small change a step on the way – no need for big scary leaps anymore.

7. Feedback, feedback, feedback.

NHSorganisations are often especially poor at giving feedback. Whether feeding back to staff or patients,“You said. We did”builds trust and provides permission from affected people to make more change. Make sure you have great feedback loops in place. Feedback more than you think you have to.

8. Network, network, network.

GPs, practice managers and nurses confirm that support from professional networks really helps primary care make and sustain change. Having someone who has done it, tell their story, inspires hope. Networks provide a rich source of information, advice and know-how, as well as peer support to help you think around the problem. Join as many networks as possible and make change together.

9. Focus on what is working well.

It is human nature to focus on the things that went wrong. Appreciating equally what is working well keeps you focused on the positive and keeps the team going.

10. Just do it! Then celebrate.

In the end, we just need to do it.Know you will learn by doing it as well. Accept you might make mistakes. And when it starts to work, remember to celebrate!

Celebration is really important and often missed out. Include celebration events in your formal plan. Combine celebration with reflection. Use celebrations to track how far you have come and what you have learnt along the way.Through celebration, we build relationships and create shared memories that mean when you ask people to join in next time, they will want to.

Georgina has over 28 years-experience in health service design. Most of her career has focused on prototyping and spreading innovations in service and system management design in both for prfit and not for profit organisations. She is a social entrepreneur and through The ELC Programme has invested in designing and spreading new approaches to person centred whole system management and innovations in clinical practice like group consultations. She also works nationally and is on the Executive Board of The NHS Alliance where she is supports health creation with a particular focus on designing health creating outcomes measurement tools and systems and creating health through work.

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